Indian Pediatrics 2001; 38: 927  

Tetanus Immunization in Injured Individuals

An adult whose childhood immunization status is not known is usually asked to take a dose of tetanus toxoid after any injury if he has not received this vaccine in the previous six months. Is it a right practice? How often and how many doses he can have in his life time?

K.B. Rangaswamy,
Deputy Surgeon,
ESI Hospital, Wadi Road,
Shahabad, Gulbarga 585 229, India.

If the question is taken literally, the answer is that the described practice is not correct. Every injury does not require tetanus prophy-laxis, but since everyone deserves it, an injury may be used as an opportunity to initiate tetanus immunization in previously unimmunized persons. The gap of six months to repeat tetanus toxoid (TT) infection is unscientific and against medical teaching. So, what is the correct practice?

In previously unimmunized persons, the primary series of TT should be given with two doses 4-8 weeks apart and the third dose 3 to 7 months after the first. An alternate and more usual practice is to give three doses 4 weeks apart. This is for future protection, but not for the current injury.

If an unimmunized person has a tetanus-prone injury, passive immunization must be given and at the same time active immunization also commenced. In the majority of persons, active immunity developes only after the second dose. Therefore, active immunization will not protect from risk of tetanus due to injury that occurred prior to the start of immunization. The third dose ensures longer duration of protection and immunological memory, and later boosters perpetuate them. In children who have taken 5 doses during the six years of life, no additional dose is necessary or advisable within the next five years. Regular boosters in adults are recommended only at intervals of 10 years. More frequent injections of TT may be associated with increased incidence and severity of reactions.

Even though TT is a safe vaccine, the total life time number of doses may be restricted to about ten up to 50-60 years of life. One or two more doses do not do harm, if thought to be essential for protection in specific situations.

T. Jacob John,
Emeritus Medical Scientist (ICMR),
439, Civil Supplies Godown Lane,
Kamalakshipuram,
Vellore TN 632 002, India.
E-mail: [email protected]